The Fight For Health Sector Reforms

Narayan Upadhyay

Dr. Govinda KC, the orthopaedic surgeon of the Tribhuwan University Teaching Hospital, has been staging his widely-reported fast-unto-death protest. This is the 11th time the TUTH doctor has observed his hunger strike, demanding with the government that the latter must implement several reforms in the nation’s health sector. It has already been more than a week that the doctor has started his fast, protesting the government’s inaction in implementing past agreements and addressing his demands. Dr. KC’s representatives have recently held several rounds of discussions with the health minister, education minister and health secretary over the endorsement of the Health Profession Education (HPE) Bill and also held talks regarding the issue pertaining to the autonomy to the Institute of Medicines. The doctor and his team are highly dissatisfied over the government’s failure to implement the recommendations made by the Professor Kedar Bhakta Mathema led commission formed to recommend the government about the reforms to be introduced in the medical studies, IoM and overall health sector which would absolve the sector from the several vices.The successive governments have failed to fulfill their promises and could not implement the agreements reached with the agitating surgeon during his ten rounds of protests. Whenever the doctor staged his protest, he received wider support from the health practitioners that included simple health workers to senior and junior doctors working in the government and non government hospitals as well as a large section of public. This support shown to the agitating doctor, who has earned fame for his humanitarian and selfless works in the health sector, often compelled the successive governments to make promises and agreements with the doctor only to fail to fulfill promises and implement the agreements. Every time the surgeon observed the fast-unto-death protest, the government promised to him that it would initiate the implementation of the recommendations of the Mathema Commission and move forward towards endorsing the HPE Bill. But the reforms have yet to start in the medical sector, which forced the old doctor to sit for the fast-unto-death protest for the 11th time.Why this failure on the part of the government authority to implement reforms in the medical studies as well as whole medical sector as per the demand of the doctor? Commentators say that the health sector is still in the tight grip of the health mafia that does not allow anyone to get rid of the vices which have made the easy, affordable health services accessible to the common people. The mushrooming of the private health centres and medical colleges are behind the rapid growth of vices in the health sector which the orthopaedic surgeon wants to get rid of. The so-called health mafia has taken the sector under its grip so tightly that even the government authority finds it hard to absolve the sector from all the existing vices. The mafia does not allow anyone to change the status quo in the health sector, because if the sector witnesses reforms it would hit hard mafia’s interests.The surge in the number of the private health centres and medical colleges in the country the common people have to pay high fees for availing of health services, while the government hospitals across the nation have been criticised for its utter failure to provide quality health services to the needy ones. Critics say that the health practitioners who are in the decision making places at the government-run hospitals often have work in close nexus, only to make the government hospitals inefficient. Due to such nexus, most of the doctors of the government hospitals and institutes are found having their stakes at the private health centres. These centres are the reasons that make easy and affordable health services quite inaccessible for the poor and needy ones. On the other hand, the successive governments had failed to expedite the process to pass the HPE bill from the parliament at the earliest. Now, as Dr. KC has been staging his 11th round of protest, the government authority- mainly the Health Ministry and Education Ministry appear to have sprung into action to get the parliament’s endorsement to the bill. However, many lawmakers have registered amendment proposals, expressing their concerns about some clauses in the bill. Some leaders of the UML have objected to the clause that prohibits the opening of the medical colleges in Kathmandu for next 10 years. Another UML leader filed proposal seeking amendment to the clause which dictates that the new medical colleges must have 300-bed facility. These UML leaders are known for criticising Dr. KC for his demand. These leaders have their stakes in the Manmohan Memorial Health Academy, a medical college. Owing to the Dr. KC protests in the past, the government has acquired the Academy, much to the dismay of the political leaders who had earlier used the political clout to run the MBBS courses in the college without having the fundamental requirements. Dr. KC lately targeted the existing anomalies in the medical studies sector. The operators of the private medical colleges often charge high fees from students aspiring to become doctors. He demanded that the fees should be lowered at all medical colleges while the colleges must be run with all facilities. He also demanded that the process to enrolment of the students must be done on the basis of merit lists in the government medical colleges. This is because of the Dr. KC that the process of enrolment was made easier and the capitation fee was lowered for the medical students in recent years. Still, some private medical colleges have not followed the new provision. He also asked the government and political parties to make appointments at IoM on the basis of seniority and not on the basis of political affiliation or political sharing. He contended that the appointees who get the posts because of his/her political affiliation, then such appointees are bound to perform his tasks as political workers or cadres, even making the health centres a recruiting centre for workers and cadres of the parties they belong to.Dr. KC’s demands have indeed riled many who wanted to take undue benefits in the health sector. These elements, rightly termed as health mafia, so far have tried their best to block needful reforms in the health sector. The senior health practioners, political leaders and many those who have stakes in the hospitals, private health centres, medical colleges and political appointments at the government health instates are the ones who have shown their resent to the Dr. KC demands that largely seek to absolve the health sector of many anomalies and vices.Because of the failure of the government and political parties in implementing the past agreements in due time, elements inimical to the reforms in the health sector often rear their ugly heads whenever the Dr. KC remains silent and people tend to forget his past hunger strikes. However, it is the government and parties that must work in tandem to fulfill their past promises and accords reached with the orthopaedic surgeon. Reforms in health sector, as envisioned by the agitating doctor, would only benefit a large section of masses in the country.